产时电子胎心监护图形的显著变化：与新生儿发病率和脐动脉血气异常的关系。
Marked variability in intrapartum electronic fetal heart rate patterns: association with neonatal morbidity and abnormal arterial cord gas.
机构信息
Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Washington University in Saint Louis School of Medicine, Saint Louis, MO, USA.
The University of Texas at Austin Dell Medical School, Austin, TX, USA.
出版信息
J Perinatol. 2020 Jan;40(1):56-62. doi: 10.1038/s41372-019-0520-9. Epub 2019 Oct 2.
OBJECTIVE
Investigate marked variability in fetal heart rate (FHR) patterns before delivery and its association with neonatal morbidity and abnormal arterial cord gases.
STUDY DESIGN
Prospective cohort of laboring patients at term. Composite neonatal morbidity (respiratory distress, mechanical ventilation, suspected sepsis, meconium aspiration syndrome, therapeutic hypothermia, hypoxic-ischemic encephalopathy, seizure, and death) and abnormal arterial cord gases (pH < 7.10, lactate ≥ 4 mmol/L, base deficit < -12 mEq/L) were assessed with multivariable logistic regression.
RESULT
Three hundred and ninety (4.5%) neonates had marked variability in FHR patterns before delivery. There was no difference in composite neonatal morbidity (aRR 1.22; 95% CI 0.91-1.63), though neonates with marked variability in FHR patterns were more likely to have a respiratory distress (aRR 1.85; 95% CI 1.25-2.70). There was an increased risk of composite abnormal arterial cord gases (aRR 1.66; 95% CI 1.47-1.88).
CONCLUSION
Marked variability in FHR patterns was not associated with composite neonatal morbidity but was associated with abnormal arterial cord gases.
目的
研究分娩前胎儿心率（FHR）模式的显著变化及其与新生儿发病率和异常动脉脐带血气的关系。
研究设计
这是一项在足月分娩的孕妇中进行的前瞻性队列研究。使用多变量逻辑回归评估复合新生儿发病率（呼吸窘迫、机械通气、疑似败血症、胎粪吸入综合征、治疗性低体温、缺氧缺血性脑病、癫痫发作和死亡）和异常动脉脐带血气（pH<7.10、乳酸≥4mmol/L、碱缺失<-12mEq/L）。
结果
390 名（4.5%）新生儿在分娩前存在 FHR 模式的显著变化。复合新生儿发病率无差异（ARR 1.22；95%CI 0.91-1.63），但 FHR 模式存在显著变化的新生儿更有可能出现呼吸窘迫（ARR 1.85；95%CI 1.25-2.70）。复合异常动脉脐带血气的风险增加（ARR 1.66；95%CI 1.47-1.88）。
结论
FHR 模式的显著变化与复合新生儿发病率无关，但与异常动脉脐带血气有关。
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